Generic Levaquin

By Barbara J. Daley, RN, PhD
Reviewed by Maggie English, PharmD, MBA, BCPS, CSP
Last Update: August 20, 2024

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What is it?

Levaquin is a synthetic broad-spectrum antibacterial drug. It belongs to the group of fluoroquinolones containing as the active substance levorotatory isomer – ofloxacin. This antibiotic blocks DNA gyrase, violates supercoiling and cross-linking of DNA breaks, inhibits DNA synthesis, causes profound morphological changes in the cytoplasm, cell wall and membranes. It is active against most strains of microorganisms, both in vitro and in vivo.

Indications

It is prescribed in the cases of infectious and inflammatory diseases caused by susceptible microorganisms:

• acute sinusitis;
• exacerbation of chronic bronchitis;
• community-acquired pneumonia;
• complicated urinary tract infections (including pyelonephritis);
• uncomplicated urinary tract infections;
• prostatitis;
• infections of the skin and soft tissues;
• septicemia/bacteremia associated with the above indications;
• intra-abdominal infection.

Dosage and mode of application

Levaquin in the solution for infusion can be administered intravenously in a dosage from 250 to 750 mg once a day. Duration of administration lasts from 60 to 90 minutes. Further on, it is possible to switch to treatment with the oral drug form. The duration of treatment depends on the symptoms’ severity and the pathogen sensitivity to the antibiotic. After the symptoms disappear, treatment is continued for another 2 or 3 days.

Overdose

There is currently no information about an overdose of this generic antibiotic in humans. When studying the effects of the drug on rodents it was found that it can cause ataxia in mice and rats in high doses, decreased locomotor activity, shortness of breath, ptosis, tremor and convulsions. When treating an overdose, the patient is recommended to immediately lavage the stomach, prescribe adequate hydration and symptomatic treatment.

Contraindications

• Hypersensitivity to levofloxacin or to other quinolones;
• Renal failure (with creatinine clearance less than 20 ml/min);
• Epilepsy;
• Tendon lesions with previous treatment with quinolones;
• Childhood and adolescence (up to 18 years);
• Pregnancy and lactation.

It should be used with caution in the elderly due to the high probability of the presence of a concomitant decrease in renal function, as well as a deficiency of glucose-6-phosphate dehydrogenase.

Side effects

• Allergic reactions: itching and redness of the skin, general hypersensitivity reactions (anaphylactic and anaphylactoid reactions) with symptoms such as urticaria, bronchoconstriction, and possibly severe suffocation, swelling of the skin and mucous membranes, a sudden shift in blood pressure, increased sensitivity to solar and ultraviolet radiation, allergic pneumonitis, vasculitis, severe skin rash, for example, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell’s syndrome) and exudative erythema multiforme.
• Digestive system: nausea, diarrhea, increased activity of hepatic enzymes (for example, alanine aminotransferase and aspartate aminotransferase), loss of appetite, vomiting, abdominal pain, digestive disorders, diarrhea with blood, pseudomembranous colitis.
• Metabolism: a decrease in the concentration of glucose in the blood, which is of particular importance for patients suffering from diabetes mellitus (possible signs of hypoglycemia: increased appetite, nervousness, perspiration, trembling). The simultaneous application with other quinolones suggests that they can cause exacerbation of porphyria in patients already suffering from this disease. A similar effect is not excluded when using this drug.
• Nervous system: headache, dizziness and/or numbness, drowsiness, sleep disturbances, anxiety, paresthesias, trembling, psychotic reactions such as hallucinations and depressions, agitation, convulsions and confusion, visual and hearing disturbances, taste disturbances and sense of smell, lowering of tactile sensitivity.
• Cardiovascular system: increased heartbeat, lowering blood pressure, vascular (shock-like) collapse, lengthening the Q-T interval.
• Musculoskeletal system: tendon lesions (including tendinitis), joint and muscle pain, tendon rupture (for example, Achilles tendon), muscle weakness, muscle lesions (rhabdomyolysis).
• Urinary system: increased levels of bilirubin and creatinine in serum, deterioration of renal function up to acute renal failure, interstitial nephritis.
• Hematopoietic organs: an increase in the number of eosinophils, a decrease in the number of leukocytes, neutropenia, thrombocytopenia, agranulocytosis and the development of severe infections (persistent or recurrent fever, deterioration of overall well-being), hemolytic anemia, pancytopenia.
• Others: general weakness, fever.

Pregnancy and breastfeeding

The drug is contraindicated for use during pregnancy and lactation (breastfeeding).

Interactions

• There are reports of an expressed decrease in the convulsion threshold with simultaneous use of quinolones and substances, which in turn can reduce this threshold. Equally, this also applies to the simultaneous use of quinolones and theophylline, fenbufen or similar NSAIDs.
• The effect of Levaquin (levofloxacin) is significantly reduced with simultaneous use with sucralfate, magnesium- or aluminum-containing antacids, as well as with iron preparations (the interval between doses must be at least 2 hours).
• When used simultaneously with indirect anticoagulants, monitoring of blood coagulation parameters is necessary.
• The renal clearance of levofloxacin is slightly reduced when used simultaneously with cimetidine and probenecid (has almost no clinical significance, but the use of this combination requires caution, especially in patients with impaired renal function).
• When combined, levofloxacin slightly increases the T1/2 of cyclosporine.
• Simultaneous use with glucocorticosteroids increases the risk of tendon rupture.

Safety precautions

When prescribing a drug to elderly, remember, patients in this group often suffer from an impaired renal function.

In severe pneumonia caused by pneumococci, Levaquin may not produce an optimal therapeutic effect. Hospital infections caused by certain pathogens (including Pseudomonas aeruginosa) may require combined treatment.

During treatment with this antibiotic, a seizure may develop in patients with previous brain damage caused, for example, by stroke or severe injury. Convulsion readiness may also increase with simultaneous use of fenbufen (or with other NSAIDs of a similar chemical structure).

Tendinitis is rarely observed when treating levofloxacin (primarily inflammation of the Achilles tendon). It can lead to tendon rupture. In the elderly or with the simultaneous use of GCS, the risk of developing tendonitis is higher. If you suspect that you have tendonitis, you should immediately cancel this antibiotic and begin appropriate treatment of the affected tendon.

In patients with glucose-6-phosphate dehydrogenase deficiency, the use of fluoroquinolones may develop hemolysis.

On the background of the use of the drug, every patient should avoid alcohol.

Use in pediatrics

Levaquin cannot be used to treat children and adolescents due to the likelihood of damage to articular cartilage.

Influence on the ability to drive motor transport and control mechanisms

During treatment, patients should avoid driving cars and other activities that require a high concentration of attention and speed of psychomotor reactions, because, on the background of the use of levofloxacin, dizziness, drowsiness, visual disturbances are possible.

How to buy Levaquin?

It becomes possible to buy Levaquin online. We only recommend visiting a doctor for discussing the cause of the disease, the dosage and course of the treatment. Self-medication will bring more harm than good for your health. In fact, online pharmacies offer lower prices than conventional drugstores. Since that, the number of customers increases considerably.

The dosage is specified by a doctor. A patient should undergo a medical examination for defining a specific treatment for your exact case. If you have any questions, you are welcome to contact our customer care support service.

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About the Author

Barbara J. Daley, RN, PhD, is a Professor Emerita at the University of Wisconsin-Milwaukee, celebrated for her 22 years of service in nursing and education. Dr. Daley, who retired in June 2019, has taught graduate courses in adult learning and qualitative research, authored over 100 scholarly works, and mentored numerous doctoral students. Her leadership extended to roles such as Associate Dean and Interim Dean in both the School of Education and the College of Nursing. Recognized with the Cyril O. Houle Scholars Fellowship, Dr. Daley continues to influence the field as an editorial advisor and respected member of various professional journal boards.

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Disclaimer: The information provided on this site is solely for educational purposes and is not a replacement for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before altering your medical treatment or medications. Relying on this content instead of seeking professional advice is not recommended.